探究应用自体髌骨股四头肌肌腱移植物修复家兔巨大肩袖损伤愈合效果的实验研究。

将36只成年健康家兔随机分为3组，分别为对照组（n=12）、缝线修复组（n=12）、移植物修复组（n=12）。对照组切开一侧肩关节，暴露肩袖肌腱后缝合伤口；缝线修复组采用经骨缝合方法将切断的肩袖肌腱缝合至肱骨大结节；移植物修复组将自体髌骨股四头肌肌腱移植物缝合至肩袖破裂处，髌骨固定于肱骨大结节，股四头肌肌腱固定于关节盂。术后6周各组处死6只家兔进行生物力学测试，术后8周每组处死6只家兔进行组织形态学分析。

生物力学研究结果显示移植物修复组的拉力最大值明显大于缝线修复组（P<0.05），其与对照组无明显差异。组织形态学分析显示移植物修复组髌骨与肱骨愈合良好；缝线修复组可见缝合部位腱骨愈合不佳，与肱骨连接处纤维组织较为疏松。

自体髌骨股四头肌肌腱修复家兔巨大肩袖损伤可在肱骨处以骨-骨愈合方式取代腱-骨愈合，达到更好的愈合强度。

The rotator cuff is composed of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles and plays a crucial role in the movement of the shoulder joint. Rotator cuff tears are one of the most common causes of shoulder pain and dysfunction. The number of outpatient visits and surgeries for rotator cuff tears is increasing and will continue to rise as the population ages. The incidence of rotator cuff injury in athletes increases dramatically, especially in antagonistic and overhead-throwing sports. Massive rotator cuff tear (MRCT) refers to a rotator cuff defect of more than 5 cm or involving two or more rotator cuff tendons, which cannot be repaired entirely due to tendon retraction, fatty infiltration, or muscle atrophy. It is called an irreparable rotator cuff tear (IRCT) . After rotator cuff injury, patients presented with obvious shoulder pain and dysfunction. Superior capsule reconstruction (SCR) for the treatment of IRCT was first proposed by Mihata and has achieved good clinical outcomes. However, there are still some patients with postoperative retears. The main area of retear after rotator cuff injury occurs at the tendon-bone junction in the rotator cuff footmark area. The main reason is that the tendon-bone junction fails to form true tendon-bone healing but scar healing after rotator cuff repair. There are a variety of grafts available for SCR surgery, but all of them are soft grafts. The final healing mode of humeral foot marks is tendon-bone union, and the healing strength is lower than that of the normal tendon-bone junction.

To investigate the healing effect of autologous patella quadriceps femoris tendon graft in repairing massive rotator cuff injury in rabbits.

Thirty-six healthy adult rabbits were randomly divided into three groups: the control group (n=12) , the suture repair group (n=12) , and the graft repair group (n=12) . In the control group, the shoulder joint was cut open, the rotator cuff tendon was exposed, and the wound was sutured. In the suture repair group, the severed rotator cuff tendon was sutured to the greater tuberosity of the humerus by transosseous suture. In the graft group, the patella quadriceps femoris tendon graft was sutured to the rotator cuff rupture, the patella was fixed to the greater tubercle of the humerus, and the quadriceps femoris tendon was fixed to the glenoid. Six weeks after the operation, six rabbits in each group were sacrificed for biomechanical testing. Eight weeks after the procedure, six rabbits in each group were sacrificed for histomorphological analysis.

The results of the biomechanical study showed that the maximum tension of the graft repair group was significantly higher than that of the suture repair group (P<0.05) , and there was no significant difference between the graft repair group and the control group. Histological analysis showed that the patella and humerus healed well in the graft repair group. In the suture repair group, the tendon-bone was not well recovered at the suture site, and the fibrous tissue at the humerus junction was loose.

Autologous patella quadriceps femoris tendon repair of massive rotator cuff injury in rabbits can replace tendon-bone healing with bone-bone healing in the humerus and achieve better healing strength.